african lab
Pros Quarraisha Abdool Karim explains how to use an applicator

Africa has the scientific and intellectual capital to develop new interventions to tackle global health challenges. Particularly when local problems emerge, surely local research is the best path towards a solution. But pursuing this path requires funding that will support and promote the growth and expertise of Africa’s scientists. 

Africa is plagued by many epidemics — from tuberculosis and HIV/AIDS to malaria and wild polio — but the continent has also worked for decades to fight these threats. The key to beating these deadly diseases is turning inward to existing expertise and finding locally driven solutions.

The recent COVID-19 pandemic has placed public health back in the global spotlight and has also served as a reminder that science is not undertaken in an ivory tower. Science shapes humanity because it takes place among us. COVID-19 has also showcased that no epidemic takes place in isolation. Through collaboration, we can build on the foundations of our knowledge to bring forward innovative ways to address health challenges that benefit all of humanity.

This is not a new idea. In fact, it is something that we became all too familiar with during the AIDS pandemic.

From despair, pain and loss to transformational research

Despair, pain, and loss were rampant during the 1980s and early 1990s, at the beginning of South Africa’s HIV epidemic. Every weekend, white funeral tents in rural KwaZulu-Natal seemed to mushroom up and multiply, signifying the growing toll the virus was taking on the country.

Witnessing this helped catalyse me to undertake one of the earliest population-based studies that looked closely at this emerging health issue in South Africa. HIV prevalence was low at the time, with less than 1% of the population having been infected.

But lurking within the data was a shocking revelation: young women (15-24 years old) were six times more likely to be infected compared to their male counterparts.

We knew something had to be done. That meant understanding what had led to this striking disparity in risk. So, we began speaking to women from all parts of society to try and get a better sense of what they were experiencing. 

Power dynamics of relationships disrupting disease prevention

Here’s what we learned: power dynamics of relationships and sex were disrupting disease prevention. Women didn’t have the ability to protect themselves because of the limited options available to them — options like condoms, that placed the responsibility of reducing risk in the hands of men.

 Meanwhile, cases continued to surge in South Africa at an alarming rate, doubling annually in the general population.

Existing methods to prevent HIV infection weren’t going to cut it. Approaches designed in the global North were never going to be able to fully account for the needs of women in Africa. That’s why new solutions had to be brought forward instead.

Tenofovir: pathfinding protection from infection 

One way that we sought to empower women was through a gel that contained Tenofovir, an antiretroviral (ARV) medication. This innovative approach, shown in the CAPRISA 004 trial, enabled HIV-negative women to protect themselves from the virus. CAPRISA’s research on PrEP was recently recognised by the  VinFuture Prize as a lifesaving innovation from the global South. 

Today, Tenofovir is taken daily as a pill for HIV prevention, a solution also known as pre-exposure prophylaxis (PrEP). It has been adopted by the World Health Organization (WHO) as a key prevention option for both women and men.

And it hasn’t stopped there — a range of new anti-retroviral drugs and long-acting formulations, delivered as injections and implants, are currently being evaluated to expand prevention choices.

AIDS is no longer a fatal condition, instead it is chronic yet manageable. But we still see too many deaths and new HIV infections, particularly in marginalized populations. Two-thirds of all people living with HIV/AIDS are in sub–Saharan Africa and the region accounts for 60% of all new infections.

Saving the gains made in HIV 

As we turn our focus towards other pandemics, such as COVID-19, we cannot afford to lose the gains made in HIV. It is a trap we fell into before — when early HIV work overshadowed TB efforts — and it is not one we can afford to be caught in again.

Even now, COVID-19 continues to draw on lessons from the decades of work that have been poured into our HIV/AIDS response. This includes leveraging existing testing tools to detect COVID, utilising clinical trial infrastructure to expedite vaccine development, calling on community engagement processes to educate the public, and relying on scientific expertise to guide governments in their response.

The AIDS pandemic has taught us that scientists, policy-makers, and civil societies cannot work in a vacuum. There must be a unity of purpose that galvanises the steadfast support of global leaders in governments and funding agencies across the world.

Africa has the scientific leadership and intellectual capital to develop new technologies and interventions. This is something we have shown time and time again. If there is a problem, then local research is surely the best path toward finding a solution.

Pursuing this path of innovation requires funding that will support and promote the growth and expertise of Africa’s scientists. Our inter-dependency and shared vulnerability underscores the importance of collaboration and resource-sharing both globally and regionally that must be used for the benefit of humanity. There is no time for complacency. We must ensure that solutions are tailored by local research to best benefit those in need.

Quarraisha Abdool Karim

Professor Quarraisha Abdool Karim is an infectious diseases epidemiologist and Associate Scientific Director of the Centre for the AIDS Programme of Research in South Africa (CAPRISA). A researcher of HIV/AIDS, she  played a key role in the development of pre-exposure prophylaxis (PrEP), a daily pill to prevent HIV. Professor Abdool Karim was a 2021 Laureate of the VinFuture Prize, in the ‘Innovators from developing countries’ category.

Image Credits: CAPRISA.

Dr Ahmed Ogwell Ouma, Acting Director of the Africa Centres for Disease Control.

Eritrea has yet to start vaccinating its citizens against COVID-19, whereas two African countries – South Africa and Tunisia – are now offering citizens over 50 a second COVID-19 booster vaccine.

However, but the vaccination rate on the continent is far behind the global vaccination target of 70%.

Dr Ahmed Ogwell Ouma, Acting Director of the Africa Centres for Disease Control, told a media briefing on Thursday that only 17.3% of Africans had been vaccinated against the virus, describing it as “very far from our target of 70% that we set last year”. 

Ten of the 54 member states have vaccinated over 35% of their citizens, with the small island states of the Seychelles (80.6%) and Mauritius (76.5%) leading.

They are followed by Rwanda (62.6%), Morocco (61.7%), Botswana (61.3%), Cabo Verde (54.6%), Tunisia (52.7%), Mozambique (43.1%) Sao Tome and Principe (40%) and Lesotho (37.6%). 

Some 37 of the 54 countries in Africa are offering boosters.

Boosters encouraged

“We are encouraging our member states to offer booster doses to citizens who have already received their full vaccination coverage, so as to ensure that their immunity remains high and to avoid situations of serious illness amongst those who have been vaccinated,” said Ouma.

Some 818 million COVID-19 vaccine doses had been procured by the 54 member states and about 70% of this (579 million) had been administered.

In the past month, there has been a 90% surge of cases in east Africa, 36% increase in the Northern region, 35% increase in the Western region and a 12% increase in the Central region. However, there has been a 19% decrease in the Southern region 

 Ethiopia reported a 109% average increase in the number of cases, while Kenya saw a 70% average increase. In the Democratic Republic of Congo (DRC), cases increased by 51% and Nigeria saw a 41% increase. However, cases Egypt 60% average decrease South Africa 23% average decrease 

“This month marks a historic milestone in Africa, the sequencing and sharing of the 100,000th SARS-CoV-2 genome,” Ouma noted, describing this as an example of an advance in science on the continent.

Shortage of monkeypox vaccine

Monkeypox is endemic in 10 African countries and seven of these and one non-endemic country have reported a total of 1,495 monkeypox cases since the beginning of this year. There have been 66 people deaths, a case fatality rate of 4.4%

The vast majority of cases have been recorded in the DRC, with 1284 cases and 58 deaths. Nigeria follows with 66 cases with one death.

 

Cameroon has reported 25 cases and two deaths, the Central African Republic has 17 cases and two deaths, Congo Brazzaville has five cases and three deaths. Liberia (seven cases), Sierra Leone (two cases) and Ghana (one case) have not had any deaths.

“Only one non-endemic country in Africa is reporting a case and that is Morocco, which has reported one case, which seems to have a travel history to France during the preceding days,” said Ouma.

“Africa CDC has already activated a team within our Emergency Operations Centre, that is following very closely and monitoring the situation on the continent and also globally,” said Ouma. “We have also initiated a One Health approach to this particular intervention by bringing on board all our assets beyond human health in animal health and the environment to be able to get an accurate picture across the continent.”

Ouma said that while the smallpox vaccine was effective against monkeypox, Africa had not yet started vaccinations because of a shortage of vaccines.

“We are not yet actively vaccinating on the continent due to a lack of vaccine but we recommend the ring vaccination, where we treat those who have been diagnosed and vaccinate the people who are around them,” said Ouma. “In this way, we can be able to interrupt transmission of this virus as quickly as possible and reduce the risks for serious illnesses.”

He added that there are “very small stocks of vaccine stockpiles across the world”, and the World Health Organization (WHO) only had a small amount of about 2.4 million doses.

“In Africa, we do not yet have any stockpile and we are working with countries to see if there will be need to go beyond isolation and interruption of transmission using non-pharmaceutical methods,” he added.

 

mariupol
Woman boiling water in Mariupol

Fears of cholera have emerged in the ruined and Russian-occupied Ukrainian port city of Mariupol. 

Exiled local officials have voiced concern over the drinking supply in the city, which has been contaminated as a result of decomposing bodies and garbage. 

“The city has really turned into one with corpses everywhere,” said mayoral aide Petro Andryushchenko on national television. “They are piled. The occupiers cannot cope with burying them even in mass graves. There is not enough capacity even for this.”

Andryushchenko said that Russian occupiers of Mariupol are considering quarantining the city in response to the potential outbreaks. 

“You can enter the city with a residence permit in Mariupol. But this is a one-way ticket, because you cannot leave,” he said. 

“Of all the possible scenarios to fight the epidemic, in our opinion, Russia has chosen, as always, the most cynical one — just to close the people in the city and leave everything as it is: Whoever survives, survives.”

In order to access clean water, Mariupol residents must queue for hours, Andryushchenko said on Telegram, with water available every two days at most. Mariupol mayor Vadym Boychenko has also said last month that due to problems with the water supply, the city may face an infectious catastrophe, and more than 10,000 people may die at the end of the year. 

Citizens lining up for water in Russian-occupied Mariupol.

National authorities monitoring potential outbreaks 

Ukrainian national authorities have begun monitoring potential cholera outbreaks across the country 1 June, with Ihor Kuzin, Ukraine’s chief sanitary doctor, calling Mariupol’s situation especially dire. 

“We can’t be 100% sure that there will be disease outbreaks,” he said. “But all prerequisites for them are already there.”

In response to growing concern of cholera, WHO Ukraine has “positioned cholera treatment and vaccination supplies in the area,” said WHO spokeswoman Margaret Harris in a WHO Ukraine press release Wednesday. 

No official reports of cholera to WHO – yet

Ibrahima Socé Fall, WHO Assistant Director-General for Emergencies Response

While the World Health Organization (WHO) has not been able to verify any report of cholera in the southeastern Ukrainian city, following public health risk analysis and needs assessment, officials have said that given the conditions of the city, it is to be expected. 

“Since the beginning of the attack in Ukraine, we have been highlighting the risk of infectious disease, including cholera, measles, typhoid fever, and other waterborne diseases because of the living conditions,” said Ibrahima Socé Fall, WHO Assistant Director-General for Emergencies Response, a press briefing Wednesday. 

“We haven’t received any report of cholera so far, but that is something we expect.” 

Last month, WHO said that it was sending cholera medicine to the central Ukrainian city of Dnipro, to prepare for possible outbreaks. WHO officials highlighted the dangerous conditions of Mariupol. 

“There are swamps, actually, in the streets and the sewage water and drinking water are getting mixed,” said Dorit Nitzan, a regional emergency director at WHO. “This is a huge hazard. It’s a hazard for many infections, including cholera.”

Deteriorating water, sanitation, and hygiene infrastructure have heightened risk of cholera, said a report conducted by the WHO’s Health Cluster Ukraine agency in April. The warmer weather of spring and summer can also increase the risk of transmission. 

“The weather is hot. There are still dead bodies on the streets of the city — especially under the debris of residential buildings. In some blocks, it is impossible to walk by — due to the stench of rotten human flesh. There was no rain for a while, and it is getting hotter,” a resident of Mariupol, who did not want to be named for security concerns, told ABC News.

Image Credits: OCHA Ukraine/Twitter, Lesia Vasylenko/Twitter.

WHO Briefing, 8 June

Confirmed cases of monkeypox reported to WHO outside of Africa’s endemic zone have doubled once again since last week, 1 June – with more than 1000 cases now having been reported in some 29 countries that don’t usually see the disease. 

So far, no deaths have been reported in those countries. But some 66 deaths have been recorded among the 1400 cases reported in central and western Africa since the beginning of the year, said WHO Director-General Tedros Adhanom Ghebreyesus, speaking at a press briefing on Wednesday. 

WHO Director-General Tedros Adhanom Ghebreyesus

While WHO is “clearly concerned” about the spread of the disease outside of Africa, Tedros also contrasted the sudden interest in the cases seen abroad with the neglect of the disease in the dozen or so central and western African countries where monkeypox is endemic. 

“This virus has been circulating and killing in Africa for decades. It’s an unfortunate reflection of the world we live in, that the international community is only now paying attention to monkeypox because it has appeared in high-income countries,” said Tedros. 

“The communities that live with the threat of this virus everyday deserve the same concern, the same care and the same access to tools to protect themselves.” 

Still unclear if asymptomatic people can transmit the infection 

monkeypox lead
Rosamund Lewis, WHO lead on monkeypox

There remains, however, a “window of opportunity to prevent the spread of monkeypox in those who are at highest risk right now,” said WHO’s monkeypox technical lead Rosamund Lewis at the briefing. 

She noted that most of the cases occurring outside of Africa so far have been among men who have sex with men.

“It is possible to control the further onward spread of this outbreak at this time with standard public health control measures, and this includes contact tracing, surveillance, clinical care, and that folks should remain isolated for as long as they are infectious,” she said.  

However, she also admitted that cases among women are appearing. And there are still many unknowns regarding transmissibility, including potential for asymptomatic transmission of the infection as well as the extent of aerosol (airborne) viral transmission. 

Gathering data on available vaccines and efficacy

The smallpox vaccine protects against monkeypox.

WHO is currently assessing the types and quantities of vaccines available globally, as well as the extent to which vaccine manufacturers have capacity to step up their production and deployment  – with the aim of developing an equitable distribution plan for available vaccines.  

Available vaccines include strategic stockpiles of smallpox vaccines, new vaccines targeted against monkeypox, and even vaccines against chickenpox, the experts said. 

But WHO is not recommending that countries launch campaigns for mass vaccination, Lewis and other experts stressed. Rather, targeted vaccination of the close contacts of infected people, health workers and other caregivers should be the priority for the limited quantities of vaccines that exist today. 

Sylvie Briand, WHO Director of Epidemic and Pandemic Preparedness and Prevention

“We have a limited number of cases but they are spread across different geographies. It’s not sending millions of vaccines to one place, but rather a few hundreds of vaccines to many different places in the world,” said Sylvie Briand, WHO Director of Epidemic and Pandemic Preparedness and Prevention.  

Primary driver remains skin to skin contact, other modes of transmission unclear 

A man shows the rashes on his hands caused by monkeypox.

Meanwhile, the primary driver of monkeypox transmission in non-endemic countries appears to be skin-to-skin physical contact, although other modes of transmission are possible too, Lewis said. 

“Anyone who has the virus in the mouth can also spread that through close face to face contact,” she observed.

But she added, “There’s a lot we still don’t know and more research needs to be done in this area.  Being mindful, being aware, and being knowledgeable is really important for preventing onward transmission.”  

Debates over monkeypox travel precautions erupt in the United States 

While the United States Centers for Disease Control issued and then rescinded recommendations for travelers to employ “enhanced precautions” as a result of the outbreak, WHO has not recommended any measures for the general public. 

WHO is, however, recommending that family members and health workers looking after or receiving patients with monkeypox or an undiagnosed rash, should wear a mask because of the risks of  transmission through virus-laden droplets released in close proximity. 

“The same applies for persons if they have had lesions in the mouth or on the face that they are able to transmit,” Lewis said, adding that they, too, should wear a mask.  

There have also been reports of the virus being transmitted to health workers or caregivers via fomites on surfaces such as contaminated bedding or laundry, she said. 

Regarding the knowns and unknowns of transmission, Lewis concluded: “It’s sometimes useful to think about what precautions can be taken in order to avert any risk of onward spread, and this must be nuanced with what we already know.” 

WHO will soon be releasing guidance to address how to prevent spread in these groups and settings, including sexual health clinics, emergency rooms, and dermatology clinics, she said. 

More vaccines may be needed if virus spreads 

Vaccines for smallpox can be used for monkeypox with a high level of efficacy, as both diseases are in the same family of viruses. 

Though there are enough vaccines to cover ‘current needs’, WHO anticipates needing more vaccines in the event monkeypox were to spread.

“What is really important for us is making sure we prevent further amplification of cases, reducing close contacts so that there is no further spread to communities,” said Briand.

Additionally, given the different types of vaccines available, there is currently not a ‘one size fits all’ approach to vaccination.

“There’s a lot that is not known about how to best use vaccines,” said Kate O’Brien, WHO Director of Immunization.

Post-exposure prophylaxis (PEP) vaccination  is recommended for contacts of cases with an appropriate second- or third-generation smallpox or monkeypox vaccine, ideally within four days (and up to 14 days) of first exposure to prevent onset of disease.

“Countries are deciding how they will use vaccines, and that data is collected in a way that can inform future vaccine use,” said O’Brien.  

Ecological factors driving virus spread in Africa 

Regarding the spread of monkeypox in Africa WHO also pointed to ecological factors, such as climate change, deforestation and reduced biodiversity.

“Clearly climate change is an important factor,” said Ibrahima Socé Fall, WHO Assistant Director-General for Emergencies Response. 

Deforestation increases the likelihood that zoonoses  – diseases present in animals – will make the leap to human populations. 

As forests are destroyed by loggers, poachers and miners, so are the predators of rodents, squirrels and other animals that may act as a natural reservoir for monkeypox infection.  Meanwhile, infected animals also relocate from the wild into human communities – where they are even more likely to transmit the infection to people.  

The loss of forests and related biodiversity has also played a factor in the emergence of other  recent diseases in Africa, including Ebola and Lassa fever, said Socé Fall. 

“[We need] to make sure that we can continue maintaining biodiversity, but also make sure that communities at the frontline have the knowledge and understanding to protect themselves and prevent the disease from expanding to other countries,” he said. 

See our related Health Policy Watch story here:  

https://healthpolicy-watch.news/monkeypox/

Image Credits: WHO.

Vacccination can effectively prevent mother-to-child transmission of hepatitis B – but few children in Africa receive the jab despite high prevalence

As the World Hepatitis Summit 2022 takes place this week, some 354 million people are still living with viral hepatitis, despite the fact that vaccines, treatments and even cures are now available, says Finn Jarle Rode is Executive Director at the Hepatitis Fund. 

Until now, viral hepatitis elimination has been the neglected child of global health. At a glance that may appear an odd statement to make given that both a vaccine and treatment for hepatitis B (HBV) exist.

And the 25 years that elapsed between the discovery of the HCV virus in 1989 and that of a cure for hepatitis C in 2014 represents one of the shortest periods of time for such a major R&D effort in infectious disease history. 

But these scientific breakthroughs are not enough. Today some 354 million people are still living with viral hepatitis, mainly in low and middle-income countries such as India, Bangladesh, China, and Pakistan. 

People wait to receive free hepatitis testing and treatment in Lahore, Pakistan, at a dedicated Hepatitis Prevention and Treatment Clinic.

Only 9% of people living with HBV and 20% of those living with HCV have been tested and diagnosed. Of those diagnosed with HBV infection, 8% are on treatment, while 7% of those diagnosed with HCV infection have started treatment. 

Globally 1.4 million people are dying from viral hepatitis each year. Before COVID-19, tuberculosis was the world´s biggest infectious disease killer, claiming 1.6 million lives each year. That means that hepatitis has been the world’s third deadliest infectious disease even during the pandemic.

Clearly, the World Health Organization’s (WHO) goal to eliminate viral hepatitis by 2030 is not going to be reached if the inertia being seen today remains.  

This, despite the potential benefits of doing so: Every dollar invested in HBV elimination returns up to $2.23. Every dollar invested in HCV returns up to $3.42. A $1.00 vaccine course can prevent one child from getting HBV, and $80.00 can cure someone from HCV.

Lack of political will & funding

Event at Davos on the margins of the World Economic Forum discussed the still formidable financial and political barriers to viral hepatitis elimination

The root cause of the problem is money followed by a lack of political commitment, issues covered in a 25 May panel at Davos held on the sidelines of the World Economic Forum on “Financing Viral Hepatitis Elimination”, including former New Zealand Prime Minister Helen Clark, among other speakers. Today no government clearly leads on the Sustainable Development Goal Target 3.3 of ending communicable diseases including hepatitis.

Advocacy and funding are not reaching the critical mass required to realistically end hepatitis. Polio eradication for instance, has been largely driven through the long-standing commitment of the Bill and Melinda Gates Foundation, working in unison with the WHO. We need a similar show of leadership from the philanthropic community to replicate that success with hepatitis.

The WHO estimates that only US$500 million is invested in hepatitis elimination per year. Malaria, with a comparable disease burden and lower mortality rates, receives $US3.3 billion per year.  The hepatitis response is an unfortunate example of the disconnect between science and policy-making – where tools to effectively end the epidemic are available but decision-makers lack the financial impetus to do so. 

African region sees highest HBV burden – but newborns aren’t vaccinated 

Vaccination can effectively prevent mother-to-child transmission of hepatitis B

In 2019, about 66% of the 1.5 million new HBV infections were concentrated in WHO’s Africa region. The majority of HBV transmission is driven by vertical transmission (from mother to baby). 

This is the most common and deadliest form of HBV transmission, as approximately 90% of children infected this way develop chronic HBV infection and up to a quarter of these infants also die prematurely from HBV-related causes. The younger a person is when they acquire HBV, the greater chance of chronic infection and premature death. 

Fortunately, an almost 100% effective vaccine exists to prevent HBV, delivered in a three or four-dose schedule. The first critical dose is known as a “birth dose” and must be delivered within 24 hours of birth (as recommended by WHO) to prevent 70-95% of transmission that occurs during or just after birth. Given the availability of this simple and effective intervention, no child should be born with this life-threatening, chronic disease.

But despite the high burden of HBV in the region, only 11 of 47 countries in Africa include hepatitis B birth dose (HepB BD) as part of the routine infant immunization schedule. Only six per cent of African newborns are receiving the birth dose vaccine today.

Linking up HIV and HBV services 

People waiting to receive free hepatitis C tests and vaccines on World Hepatitis Day, Rwanda. But campaigns are no replacement for integration into primary health care services

Hepatitis needs big donors to drive bilateral aid and national government buy-in. But this doesn’t have to lead to exorbitant costs. 

First of all, we need to ensure better integration of viral hepatitis treatment into existing global health programmes, and take a people-centred approach to prevention, diagnosis and treatment.  

It makes no epidemiological or economic sense, for instance, that an HIV positive pregnant woman in Kenya attending a health care centre be provided with Nevirapine to prevent her infant from contracting HIV, but not also be given access to Tenofovir prophylaxis preventing mother-to-child transmission of HBV in late pregnancy, along with an  opportunity to vaccinate her newborn against HBV.

Secondly, we need more of the public-private partnerships that have to date proven effective. Much more. And that includes external catalytic funding. We need the World Bank, the Asian Development Bank, The Islamic Bank, philanthropists, foundations.

Inroads are possible

This is not the stuff of fantasy. Inroads are possible, even in the most unlikely scenarios.  Take Egypt: it has long held the highest rate of HCV infection in the world. One person out of every 10  used to live with viral hepatitis. But in 2014 the country began implementing a strategy that has made  huge progress against the disease.

A first step was to get the buy-in of various government ministries, not just the health portfolio. The second was to make the decision to integrate hepatitis C screening with screening for non-communicable diseases (NCDs) in primary healthcare facilities. 

This approach reached some 60 million people, including nine million school children. At the same time, partnerships between civil society, the private sector and philanthropic organisations mobilised communities and drove high rates of screening, diagnosis and treatment.

Since the country’s programme began, the number of Egyptians living with hepatitis C has dropped from 4.346 million in 2014 to 516,000 in 2021.  Egypt´s remarkable response has shown that the goal of eliminating viral hepatitis is possible. With the right backing, it can be done everywhere.

Finn Jarle Rode is Executive Director at the Hepatitis Fund, a global non-profit organization that funds catalytic actions by partners, including support for the development of strategic plans at the national and sub-national level; country-specific data; and health system capacity-strengthening.

Image Credits: WHO, PKLI , WHO, WHO.

Protestors in New York City.

World Trade Organization (WTO) leaders are hopeful that an agreement could be reached on a waiver on intellectual property rights for COVID-19 vaccines at the Ministerial Council starting on Sunday – but the People’s Vaccine Alliance has organised global protests to demand “a real TRIPS waiver” ahead of the meeting.

WTO Director-General Ngozi Okonjo-Iweala has expressed “cautious optimism” that agreement on the IP waiver is possible at the council, according to WTO spokesperson Daniel Pruzin.

Speaking at a media briefing on Tuesday following a special meeting of the WTO General Council earlier in the day, Pruzin said that Ambassador Lansana Gberie, chair of the TRIPS Council, which is leading discussions on the waiver and the WTO’s response to the pandemic, was also optimistic.

According to Gberie, delegations “entered into real negotiation mode [on Monday] in an effort to try to iron out their differences, particularly with regards to the waiver discussions,” said Pruzin.

A small group meeting of the TRIPS Council on the waiver resumed negotiations on Tuesday evening.

Too little, too late?

On 3 May, Okonjo-Iweala put forward an “outcome document” on the waiver that had emerged from discussions with “the Quad” – the European Union, India, South Africa and the US.

According to the WTO, the Quad adopted a “problem-solving approach aimed at identifying practical ways of clarifying, streamlining and simplifying how governments can override patent rights, under certain conditions, to enable diversification of production of COVID-19 vaccines”.

However, there are still some sticking points on the proposal, even within the Quad, and the proposal has been widely condemned by health activists for being too little, too late. 

An IP waiver proposal for all COVID-related technology was first put on the table over 18 months ago by India and South Africa during the height of the pandemic when vaccines were in short supply. 

The current agreement is confined to COVID-19 vaccines, and it is being negotiated when there is a global glut of vaccines.

The People’s Vaccine Alliance is planning global protests during the week aimed at pressuring US and European countries to “end COVID monopolies” and “deliver a real TRIPS waiver”, the global network announced on Tuesday.

“The WTO is having its biggest meeting since the start of the pandemic. Feeling the pressure to do something on COVID, WTO leaders have introduced a bogus new proposal that not only fails to remove WTO barriers to COVID medicine accessibility, but actually introduces new obstacles,” according to the alliance.

Other big WTO agenda items

Other big items on the agenda of the WTO Ministerial Council are a reduction in fishing subsidies, agricultural trade reform and reform of the WTO itself, including more regular ministerial meetings.

Pruzin said the “significant progress” had been made on the fishing subsidies proposal, which has been negotiated for a number of years, and on  possible ministerial declaration on WTO’s response to the pandemic,

“There are still some very important differences which remain in the texts, and I think all the chairs recognise this, be it fisheries, be it agriculture, be in other areas as well,” said Pruzin.

“But I think it’s fair to say that the atmosphere is much better than it has been in some time. I think there’s some good momentum going into the final preparations.”

Image Credits: People's Vaccine Alliance.

A medical assistant gives a flu vaccination.

Moderna announced Tuesday that the first participants have been vaccinated in a Phase 3 study of its influenza (flu) vaccine, which is based on mRNA technology used in its COVID-19 vaccine.

The vaccine, mRNA-1010, encodes for hemagglutinin (HA) glycoproteins of the four influenza strains recommended by the World Health Organization (WHO) for the prevention of influenza.

Flu epidemics generally occur in the winter and some years can place a heavy burden on healthcare systems, with as many as 3 million to 5 million severe cases and, at its worst, as many as 650,000 deaths, according to WHO.

The trial is expected to enroll approximately 6,000 adults in countries in the southern hemisphere. It is a randomized, observer-blind study that is meant to evaluate the safety and immunological efficacy of mRNA-1010 in comparison to a licensed seasonal influenza vaccine in adults 18 years and older. Participants will be randomly assigned on a 1:1 ratio to receive either a single dose of mRNA-1010 or a single dose of a licensed seasonal influenza vaccine as a comparator.

The company aims to run a confirmatory efficacy study for mRNA-1010 as early as the 2022/2023 northern hemisphere influenza season.

“mRNA-1010 is the first of several influenza vaccine candidates we are developing with the aim of iteratively improving traditional vaccines by inducing broad and robust immune responses,” Moderna CEO Stéphane Bancel said in a release. “We believe our mRNA platform, with the flexibility and speed of our manufacturing process, is well-positioned to address the significant unmet need in seasonal flu.

Moderna was founded 12 years ago and became well-known two years ago with the development of its SARS-CoV2 mRNA vaccine. It was the second mRNA vaccine ever to be produced and was approved by the US Food and Drug Administration. The first mRNA vaccine was developed by Pfizer and BioNTech.

Moderna is currently engaged in four Phase III studies, it said, including its SARS-CoV-2 booster, RSV, seasonal flu and CMV vaccine candidates.

“Beginning in the fall of 2022, the company’s Phase III pipeline could lead to three respiratory commercial launches over the next two to three years,” Bancel said.

Image Credits: Moderna, KEYSTONE/Gaetan Bally.

Dr Ibrahima Socé Fall, assistant general security for emergency response

The first human case of monkeypox was recorded in 1970, yet the viral disease is only getting international attention since it has spread outside Africa to 27 non-endemic countries.

The World Health Organization’s (WHO) Dr Ebrahima Socé  Fall described monkeypox as a “neglected tropical disease” when he opened a two-day meeting called by the WHO’s R&D Blueprint to determine research priorities last Thursday.

“We need to stop the chain of transmission and we believe at this stage we can still stop the chain of transmission in non-endemic countries by ensuring surveillance in certain population groups, cross investigation contact tracing, and maybe vaccination,” said Fall, WHO’s Assistant Director-General for Emergencies Response. 

However, WHO scientist Ana Maria Restrepo stressed at the meeting’s conclusion that the viral disease had to be addressed in the nine African countries where it is endemic.

“The problem starts and has to be resolved at the level of the endemic countries,” said Restrepo, co-convenor of the R&D Blueprint that called the meeting, at the conclusion of the meeting.

“There are researchers of high quality in these countries, and they are doing high-quality research despite the limitations, and our commitment is to support them.” 

Squirrel pox?

The intention of the meeting – attended virtually by over 500 scientists – was to identify research priorities, and when it ended on Friday afternoon, the scientists had identified a long list of unknowns.

One of the big questions is whether there is an “unknown animal reservoir” for monkeypox – with squirrels and rats being fingered as the most likely suspects. The Central African sun squirrel is particularly susceptible to monkeypox – and one researcher suggested the pox might have been more aptly named after it.

“What was the first reservoir?” asked Dr Paul Fine of the London School of Hygiene and Tropical Medicine.  

“We think monkey because of the name monkeypox, but there were studies in a number of other species and it was found in several of them, in particular squirrels, particular the sun squirrel of Central Africa. So one might ask if this name is appropriate. Is it just monkeypox or are there other species very importantly, involved as reservoirs?”

SARS Co-V2 comes from bats, while monkeypox could come from rats.

Professor Jean-Jaques Muyembe Tamfum, director of the DRC’s Institute de Recherche Biomedicale, said that the majority of monkeypox cases in his country were children infected by hunting and handling rodents and squirrels.  Adults were exposed to the virus by hunting monkeys.

“The virus enters the body through the broken skin, and spreads in the mucous membranes and eyes, nose and the rest,” said Tamfum.

Complications of monkeypox include bacterial conjunctivitis and even blindness.

Scientists also raised whether rodents could be infected by “spillover” from human waste.

The meeting resolved that a “comprehensive One Health approach” was needed to understand animal-to-human transmission and animal reservoirs.

A ‘One Health’ approach is neeed for monkeypox

Mutations and drivers

Genomic sequencing of the current strain of monkeypox spreading internationally shows that it has 47 mutations when compared to a 2018 sample. 

This is surprisingly high, and one hypothesis is that the monkeypox virus has been mutating in an unknown animal – or perhaps more than one animal behind the two different clades – the Central African clade with a mortality rate of around 10% and the West African clade with a 2-3% fatality rate.

Aside from the international spread of monkeypox, there has also been a dramatic increase in cases in endemic countries especially DRC and Nigeria.

Nigeria’s Professor Dimie Ogoina told the meeting that his country was also seeing an increase in cases in areas where it had not previously been seen.

Scientists thus want to unpack what is driving the transmission, as monkeypox is not known to be particularly infectious. In the past, infected people only passed the virus on to about 8-15% of the people living in the same house.

The European outbreaks appear to stem from sexual contact at two events – in Berlin and on the Canary Islands, according to news reports. 

This is not typically how it has been transmitted, and the meeting raised a number of questions about sexual transmission – particularly whether it can be transmitted via semen and vaginal fluid, not just through contact with the infected lesions. 

“Monkeypox manifests in rashes. Would a person still engage in sex with these rashes? We need to look at asymptomatic transmission,” said Ogoina.

Tricky diagnosis

In Nigeria, men are significantly more likely to get monkeypox than women, raising questions about what makes them more vulnerable.

Ogoina, from Niger Delta University, also revealed that people coinfected with HIV and monkeypox had “bigger lesions” and were more likely to have genital lesions – although only five such patients were examined.

“It is very important just to recognise that the vast majority of recent cases, especially in DRC, are suspected cases or their probable cases or possible cases, they’re not confirmed,” stressed Fine.

Some of the symptoms of monkeypox are similar to those of syphilis and chicken pox, and the meeting identified the need for better diagnostics.

“WHO, through our regional offices, is working with African countries, regional institutions, technical and financial partners, to increase the ability to support disease surveillance laboratory diagnostics, readiness and response actions related to monkeypox,” said WHO epidemiologist Maria van Kerkhove. 

“We have to acknowledge the fact that this virus has been circulating for decades, and we now have attention to this. This unfortunately is a sad reality of the world that we live in. But we need to use this as an opportunity to advance our understanding of this virus to help everyone everywhere dealing with monkeypox,” said Van Kerkhove. 

Implementing COVID lessons

Professor Helen Rees

Professor Helen Rees, who moderated the two-day meeting, said that COVID-19 had shown the need for rapid global responses to emerging health threats.

Rees called for “partnerships, collaboration, strategies that get us into the field quickly, antivirals and vaccines”. 

“We’re also seeing this interface with One Health, with environmental degradation and climate change. All of these things are coming to the fore. Just to underline this is not a pandemic, this is an outbreak that we are scratching our heads about. But the fact that we should respond now and rapidly is really excellent,” added Rees, a renowned scientist from South Africa’s University of Witwatersrand.

WHO scientist Ana Maria Restrepo concluded the meeting by stressing that it was important to practice what had been preached during COVID-19.

“We talked very much about the new health architecture for response to pandemics, and the lessons learned,” said Restrepo. “We are convinced that showing a good response for this multi-country outbreak is our best example of how we are going to be prepared for the next pandemic. 

“If we do when we all preach, we work together if we collaborate, we use master protocols, if we engage the countries; the communities – if we learn those lessons, and if we put equity at the centre of the discussions, then yes we have learned our lessons and we are moving forward towards being better prepared,” said Restrepo.

Ana Maria Restrepo

Expedited studies

The meeting concluded with experts calling for expedited studies to better understand the disease epidemiology, clinical consequences, and modes of transmission. 

While the smallpox vaccine offers over 80% against monkeypox, it is unclear whether this protection endures – and smallpox vaccination was discontinued in the 1970s. The experts emphasized the need for clinical studies of vaccines and therapeutics to better document their efficacy and understand how to use them in this and future outbreaks. 

The meeting also called for immediate implementation of public health activities including communicating prevention information, enhanced disease surveillance, contact tracing, isolation of cases and optimized care of people with the virus.

In a world where health workers are scarce, self-care practices can drastically improve people’s quality of life and alleviate strain on health systems, but depend on a range of factors including patient literacy, fair prices and government stewardship.

This is according to a one-of-a-kind global study demonstrating the value of self-care that was launched on the sidelines of recent World Health Assembly in Geneva. 

The World Health Organization (WHO) defines self-care as “the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a healthcare provider.”

Current self-care activities around the world are generating annual savings of approximately $119 billion, along with saving 11 billion patient hours worldwide, according to the study. The study was produced by the Swiss-based Global Self-Care Federation (GSCF), which represents manufacturers and distributors of non-prescription medicines on all continents.

Self-care cost-saving (source: Global Self-Care Federation report).

Low-income countries lagging

But the low-income countries are still lagging in implementing and reaping the benefits of self-care. 

“In low-income countries, about 65% of households that could not obtain essential health services had financial constraints,” said Dr Ritu Sadana, WHO Head of Ageing and Health Division of Universal Health Coverge (UHC), one of the panelists at the launch of the report. 

“This is more than triple the proportion of households who lack access to health services because they are just unavailable, which is 20%.” 

High-income countries are reaping the most benefits of self-care practices while the low-and middle-income countries are playing catch-up.

With increased adoption of self-care, we will be seeing an additional $19.5 billion in annual cost savings related to the increased adoption of self-care by 2030, said Ben Carrick, Johnson and Johnson’s senior director of consumer policy.

“If we think about the welfare benefits, it could be leading to an annual increase of $312 billion per year globally. These are significant benefits that are worth chasing and grasping,” Carrick told the launch. 

The study grouped 155 countries based on their GDP levels, and then gauged the self-care effects. In the high-income countries (Group A), self-care is already making an indispensable contribution to relieving the burden on healthcare systems. 

But it is in the low-and middle-income countries (Group B and C), where self-care can enable a person to work and not depend on welfare.

“We don’t need more GDP; we need more welfare and this is also what this project is about, this is what self-care is about… to generate more welfare and not just be focused on figures and economic factors,” said Professor Uwe May, Dean of Studies at Fresenius University. He added that currently if people practised self-care instead of doing nothing about their health issues, 41 billion productive days can be gained on a global level. 

Self-care ‘only option’ in poor countries 

The study also found that health economic and pharmacoeconomic approaches deployed to assess the value of self-care cannot be transferred to lower-income regions where the infrastructure, socio-economic factors, and awareness is different. 

In addition, lack of access to over-the-counter (OTC) medicine and the prevalence of traditional medicines also has an impact on self-care options.  

In regions like sub-Saharan Africa and South East Asia, self-care is not an alternative care option, but is often “the only possible access to treatment for most individuals”, according to the report.

In these countries, self-care does not translate into saving on doctors’ and specialists’ time.

“This is where the welfare benefits are really the main opportunity because it isn’t saving physicians’ time and people don’t have access to the physicians,” said Carrick. 

“But if it means that they’re productive, they’re back at work and they’re able to look after families, then it’s those welfare and productivity benefits that really come into play.”. 

In Latin America and the Caribbean, the practice of self-care and the use of OTC products leads to current welfare savings of $123 per capita per year. 

The more the OTC use increases, the greater the individual and societal benefits can be realised through self-care, according to the study 

“We estimated that at least 142 million older persons, about 14% of older persons worldwide, are unable to meet some of their basic needs. So the issues around self-care for themselves or by their families or care providers is extremely important,” said Carrick.

What do we need now?

The report highlights the need for private-public partnerships, digital and healthcare literacy in people living in low-and middle-income countries (LMICs) and better parameters to gauge healthcare outcomes in a country.

“We need strong stewardship by government, and to have really strong capacities in government institutions…so that they can lead and shape how we actually get things done with the private sector, with multiple sectors across the government and also obviously, civil society and self-care demands with the active participation of people,” said Sadana. 

“Health literacy is a fundamental catalyst for change to ensure individuals comprehend and act on credible health information, becoming active self-managers of their own health,” said Carrick.

Experts at the launch also highlighted the need for pharmacies to be more involved in developing better policies, and for governments to spend more on ensuring that self-care is delivered through, not only OTC and literacy, but also nutrition, lifestyle, and affordable healthcare. 

Sadana said that in India, 70% of all healthcare costs are paid out of pocket, and 70% of that was on drugs. 

“If we’re going to have a system which encourages self-care, using products that are evidence-based and quality-controlled, we still need to have a way to ensure that those are covered [by the health system] if we actually want a vast swathe of the population to use them.” 

Image Credits: Tbel Abuseridze/ Unsplash.

Pfizer’s Paxlovid, an oral antiviral approved by the US FDA in December, has shown 90% efficacy in preventing mortality among those who take it in the first few days of infection.

Scientists and doctors are beginning to eye Paxlovid, the antiviral medicine developed by Pfizer to protect vulnerable people from severe disease, as a potential treatment for lingering COVID-19 symptoms after single patients report that the medicine has helped to reduce their symptoms.

Long COVID affects as many as one in five people infected by the virus, according to a recent report by the US Centers for Disease Control and Prevention.

The US Food and Drug Administration granted the drug emergency use authorization in December last year to prevent severe disease in high-risk patients.

“We need to be studying antiviral therapy [for the treatment of long COVID] as soon as possible,” said HIV expert Dr Steven Deeks, a professor of medicine at the University of California, San Francisco (UCSF). He told Health Policy Watch that single-patient case studies have helped drive HIV cure research and Deeks believes that the same could prove true for long COVID.

In May, researchers from Deeks’ university published a report on the Research Square preprint platform of three vaccinated individuals in their 40s who developed long COVID. Two of them were treated with Paxlovid and reported that their symptoms substantially improved.

“While single anecdotes must be interpreted with caution, these cases emphasize the urgent need for carefully designed studies to assess the impact of antiviral therapy beyond the acute window,” the researchers wrote in their report.

Anti-viral therapy

They added that the stories further suggest that antiviral therapy could “potentially impact the complex interplay between viral replication and the host immune response that likely underlies this syndrome but raise concern that brief early antiviral therapy alone may be insufficient to prevent the development of long COVID.”

A similar report was published in April on Research Square of a patient who was infected with the virus in the summer of 2021 and suffered from severe fatigue, brain fog and body aches, among other symptoms, for months afterwards. The symptoms were so severe that she could no longer work.

Six months later, she was reinfected with COVID-19. This time, her doctor prescribed a five-day course of Paxlovid. By day three she noted rapid improvement, not only in her acute symptoms resulting from reinfection, but in her long COVID symptoms.

“Her acute flu-like symptoms had already begun to self-improve by day three, but she noticed rapid improvement of her pre-existing PASC [Post-Acute Sequelae of SARS-CoV-2] symptoms after taking the antivirals,” according to the report.

“At seven months post-initial infection, her PASC symptoms had resolved, and she reported being back to her normal, pre-COVID health status and function including working fulltime and exercising rigorously.”

These cases are not proof that Paxlovid caused the relief these patients experienced as there were other factors, but Deeks said they should be enough to encourage research into the matter.

“These patient stories of people having lingering symptoms who go on Paxlovid for whatever reason and feel better, that strikes me as clearly not definitive, but clearly makes these things necessary to study right away,” Deeks said.

However, there are only a couple of handfuls of clinical trials studying any treatments for long COVID, he said, and certainly no “rigorous assessment for Paxlovid or any other antiviral drug for long COVID.”

To Deeks’ argument, in the HIV space, there has been much attention on individual cures and they “inspired the field,” he said, “they showed it could work.”

Deeks spoke to Health Policy Watch ahead of a visit to Israel for the Medicine 2042 conference in Tel Aviv, where he is expected to be speaking about “Curing HIV. What’s next?”

Long COVID is a ‘vague syndrome’

One of the challenges with researching the treatment of long COVID is that scientists are still unsure about what causes it. One theory is that long COVID may be the result of the virus persisting in part of the body at low levels that can cause local inflammation or clotting and contribute to excess morbidity.

“The dogma is that SARS causes short-term infections and goes away very quickly,” Deeks said. “But data is emerging that, if you look in the right place, you can find evidence that the virus is there.”

A recent study by the CDC showed that one in five people over the age of 18 (and one in four people over the age of 65) who recovered from COVID-19 experienced at least one symptom or condition that could be attributable to the virus. The study analyzed electronic health records of more than 60 million Americans between March 2020 and November 2021.

The Centers for Disease Control and Prevention reported in May that as many as one in five adults have a health condition that could be related to COVID-19 infection.

The long COVID symptoms were diverse and affected multiple symptoms including the cardiovascular, pulmonary, hematologic, renal, endocrine, gastrointestinal, musculoskeletal and neurologic systems, and also included psychiatric signs and symptoms.

Specifically, among those over 18, 38% of people experienced a condition compared with 16% of controls. People who recovered from COVID-19 were twice as likely to develop respiratory issues or pulmonary embolism than their virus-free counterparts.

Deeks said that such studies need to be taken for what they are: retrospective analyses based not on scientific or consistent medical testing but on how people feel.

“Long COVID is, right now, an extremely vague syndrome and that also makes it really hard for companies to invest in and regulatory bodies like the FDA to approve drugs to treat it,” he said.

Deeks said people who get COVID sometimes report incidents that are unrelated to the virus but blame the virus anyway. For example, he said that he lost his hair very quickly when he was in his 20s. If Deeks had COVID then, he said that he is sure he would have blamed the virus.

“It is hard to go back into these records and identify those individuals who have classic long COVID that we know is real. But the bad version of long COVID is not subtle. When you sit down in front of a person who six months ago was running marathons and now can barely leave the house that is long COVID,” Deeks said. “But that is not happening in 20% of the people who got COVID. My sense is that it is less than 5% with Delta. One of the most important questions on the table now is how common long COVID with Omicron is.”

Another challenge to understanding long COVID, he added, is that the world does not have enough information emanating about it from the Global South. Most of the data is coming out of the United Kingdom, United States and Israel – countries with complex electronic health records that are easy to manage and that have more resources.

Paxlovid reduced death by 81% in vaccinated patients over 65

Last week, a new observational, retrospective cohort study on Paxlovid was published on Research Square by a team of Israeli researchers that found that the antiviral drug works for people infected with the Omicron variant and individuals who have been vaccinated.

“Our study demonstrated that [Paxlovid] therapy was associated with a 67% reduction in COVID-19 hospitalizations and an 81% reduction in COVID-19 mortality in patients 65 years and above, during the Omicron surge,” explained Dr Ronen Arbel, a researcher at Clalit Health Services and Sapir College. Arbel led the study that ran from January to March, when the Omicron variant was the dominant strain in Israel.

The researchers examined the effectiveness of Paxlovid in preventing hospitalization and death from COVID-19 in patients over the age of 40 who had been identified as at high risk for COVID-19 complications. In Israel, the treatment was provided within days of diagnosis and administered for five days, per the Pfizer protocol.

There were more than 100,000 participants who were eligible for Paxlovid therapy in the study. Of the 42,819 eligible patients aged 65 years and above, 2,504 were treated with Paxlovid. Fourteen of the treated patients versus 762 of the untreated patients were hospitalized and two treated patients died while 151 of the untreated patients died.

“It was very important to us to understand if the drug also works for patients who were vaccinated or recovered,” Arbel told Health Policy Watch. “What we saw was very interesting. For people without prior immunity, we saw very similar results to the Pfizer trial – 86% reduction [in hospitalisation] while they had 89%. But the majority of real-world patients in most countries have some kind of immunity from recovery or vaccination. In these cases, we saw a 60% reduction in the older population.”

Paxlovid contraindications

Moreover, Paxlovid does have serious limitations. For starters, the drug can have contraindications with existing drugs, Arbel explained.

“We had to have a physician involved to see what drugs each patient was already getting and if they could get Paxlovid,” he explained. “Sometimes there was a recommendation to stop a few drugs for the course of the Paxlovid treatment, but some drugs you cannot stop, and this was a challenge.”

In addition, Paxlovid has uncomfortable side effects, including taste disturbance, diarrhea and vomiting. There is no long-term safety data on the drug nor any sign of what the results might be if taken for more than five days.

The FDA in May rebuked statements made by Pfizer CEO Albert Bourla in an interview with Bloomberg in which he proposed that if some patients experienced a relapse of COVID-19 symptoms after the first round of Paxlovid they could take another round.

“There is no evidence of benefit at this time for a longer course of treatment or repeating a treatment course of Paxlovid in patients with recurrent COVID-19 symptoms following completion of a treatment course,” Dr John Farley, director of the Office of Infectious Diseases, wrote.

Finally, Deeks said one of the drawbacks of Paxlovid is that while it prevents the virus from spreading it does not kill infected cells, which may be necessary in the case of people suffering from long COVID.

Vaccines offer partial protection against long COVID

Many people have asked if vaccination could prevent long COVID and most recent research is showing that vaccination only offers partial protection against persistent symptoms, so relying solely on vaccination to prevent long COVID is not likely to be enough.

A study published last month in Nature Medicine by researchers from Washington University in St Louis looked at 33,940 individuals who had been vaccinated and developed a breakthrough infection and 4,983,491 controls who had no record of a positive COVID-19 test between January 1 and October 31, 2021. The team found that being vaccinated reduced the risk of experiencing long COVID symptoms six months after diagnosis by only 15%.

A new study by Washington University researchers showed that vaccination reduces the risk of long COVID by around 15%.
A new study by Washington University researchers showed that vaccination reduces the risk of long COVID by around 15%.

However, when it came to some of the most severe long COVID symptoms – lung and blood-clotting disorders – the risks were reduced by 49% and 56%, according to the study.

“You cannot rely totally on vaccines to protect you,” Deeks stressed. “As society opens up, how you manage your COVID risk behavior will depend on how much of a concern long COVID is.”

But knowing whether or not Paxlovid may be an answer is likely a long time off.

“We don’t have so many patients that received the drug,” Arbel said. “The drug was given only to a minority of patients, so its effects on long COVID would be very interesting to look at, but it will take some time to have meaningful evidence.”

Image Credits: Pfizer , Centers for Disease Control and Prevention, Bobbi-Jean MacKinnon, "Long COVID after breakthrough SARS-CoV-2 infection" in Nature Medicine.